Organization
LIBERTY MEDICAL SPECIALTIES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMARA LYNN JONES (BILLING MANAGER)
(910) 642-2250
Entity
Organization
Contact information
Practice address
2224 S 17TH ST, WILMINGTON, NC 28401-7515
(910) 763-8229
Mailing address
PO BOX 339, WHITEVILLE, NC 28472-0339
(910) 642-2250
Taxonomy
Speciality
Code
Description
License number
State
3336H0001X
Home Infusion Therapy Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0473G
BCBS IV
NC
05
—
0656091
—
NC
01
—
3436676
NCPDP#
NC
05
—
6800282
—
NC
Enumeration date
09/07/2006
Last updated
10/03/2011
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